The slave of duty: Why clinical educators across the continuum of care provide clinical education in physiotherapy

This study was a qualitative investigation aimed at exploring clinical educator’s perceptions of the clinical education experience and barriers to providing more clinical education. An online questionnaire was sent to physiotherapy clinical educators at hospital and community sites operated by Southern Health in Victoria, Australia. Using the responses, a framework involving key themes “motivators for delivering clinical education,” “consequences of delivering clinical education,” and “beneficiaries of clinical education” was constructed. Motivation for delivering clinical education was consistently reported as duty or responsibility. Consequences of delivering clinical education were comprised of positive effects on department profile, educator professional development, student professional development, and development of the physiotherapy profession, and negative effects on non-clinical tasks. The effect of clinical education on workload was seen as both positive and negative, depending on student ability, attitude, and quantity, as well as on staffing levels. These consequences were distributed across a range of beneficiaries of clinical education, inclusive of students, educators, patients, the department, and the profession. Strategies aimed at enhancing the positive aspects and managing the negative aspects for the clinical educator may be more successful in increasing capacity for student placements.     

Skills competency in nurse education: nurse managers'' perceptions of diploma level preparation

This paper reports on part of a national study conducted between 1994 and 1996, the overall aim of which was to examine the 'fitness for purpose' of the Project 2000 nursing education reforms. The study used multiple methods of data collection, including an individual and group interview study of nurse managers (n = 132) and a national survey of Project 2000 diplomates and traditionally prepared registered nurses (n = 5417). Findings in relation to the managers' expectations and experiences of diplomates are presented. This includes views on the level of skills achievement and skills acquisition of diploma level education. The qualities of the diplomates are discussed and this includes those areas where the skills of the diplomates are felt to achieve what is required of the role. Also included is an exploration of those skills which the managers felt fell short of expectations. Managers raised the long-standing concerns of clinical skills and competencies and discussed these in relation to the changing health care environment and the relative roles of other health care workers. The conclusions highlight the need to identify what could be seen as the 'core skills' required of a registered nurse and the need to explore the environment in which the diplomate takes up first appointment.     

‘Levels’ of attainment in nursing practice: reality or illusion?

In earlier research based on an analysis of course documentation, it had been found that there was little consensus among nurse educators concerning the parameters which distinguish levels of practice skills, particularly those which differentiate diploma and degree qualifications in the United Kingdom. This result was confirmed and strengthened in the current study. Lecturers in nursing, when presented with a sorting task using 40 statements derived from course documentation selected from the earlier study, were unable to distinguish statements describing diploma level from those describing degree level practice. Possible reasons for the difficulty are discussed. It is concluded that the attempt to represent practice skill in a hierarchy of assessment for degree or diploma qualifications is premature since the parameters of practice remain unreliably specified.     

The impact of continuing professional development on ophthalmic dispensing of progressive addition lenses in the Asia–Pacific region

Background: Discrepancies exist in optometric education, practice and regulation across the Asia–Pacific region and the competence of optometric practitioners in adopting new lens technologies may vary widely. Over the past 10 years, a continuing professional development program, Varilux Academy Asia–Pacific (VAAP), was implemented and conducted in countries across the Asia–Pacific region to improve practitioners' understanding of optometric fitting principles, with special emphasis on progressive addition lenses (PAL). The aim was to demonstrate the effectiveness of VAAP and to compare the competence of practitioners across the Asia–Pacific region in new lens fitting technologies. Methods: From 2002 to 2008, all VAAP participants from 12 countries across Asia–Pacific were invited to complete a pre‐ and a post‐program competency test and a post‐program survey. Results: A total of 5658 practitioners were trained, and 69.9 per cent (n = 3,957) of participants completed the pre‐ and post‐program competency test; 80.9 per cent (n = 4,580) of participants completed the post‐program survey. There was a significant improvement in competency after VAAP (mean change = 19.4 per cent ± 3.3, p < 0.01). Before VAAP was conducted the mean competency score was significantly lower in developing countries compared with developed countries (mean score of developed countries = 50.6 ± 10.3, mean score of developing countries = 45.0 ± 7.8, p < 0.05). After VAAP, these differences were not significant. Confidence in fitting PAL improved by 27.1 per cent. Most participants (91.6 per cent) intended to fit more PAL and 96.8 per cent of participants rated the program as excellent or good. Conclusion: Our findings highlight the need for further continuing education of practitioners across the Asia–Pacific region. The results of the training course indicate that, across Asia–Pacific, continuing education courses in ophthalmic optics and dispensing encompassing modern lens design and best practice fitting principles are warranted.     

Detection of group C rotavirus in children with acute gastroenteritis in Blantyre, Malawi.

Among 606 children who were treated for acute gastroenteritis at the Queen Elizabeth Central Hospital in Blantyre, Malawi, Group C rotavirus (Gp C RV) was detected by enzyme-linked immunosorbent assay in fecal specimens from 16 (3.9%) of 408 inpatients and in 4 (2.0%) of 198 outpatients. Thirteen (65%) children excreting Gp C RV were coinfected with Group A rotavirus.     

Non-compliance and professional power

The non-compliance of patients with prescribed treatments is considered as a barrier to effective health care. Non-compliance has implications for the health of patients, effective use of resources and assessments of the clinical efficacy of treatments. Research into non-compliance has increased over the last 30 years. This seems to indicate that it is seen as an important area of concern for all health care professionals. Definitions of non-compliance are problematic, as are methods of assessment of its nature and frequency. Many factors which may account for non-compliance have been proposed, as well as methods to improve compliance. Research into these factors however, mainly based on a positivist epistemology, has failed to provide any conclusive answers to the problem. Sound clinical reasons are suggested as the basis for the increase in interest in non-compliance. It is contended, however, that it is not only these reasons that account for the identification of non-compliance as a problem. Non-compliant behaviour is seen as problematic, because it contravenes professional beliefs, norms and expectations regarding the ‘proper’ roles of patients and professionals. These have formed the basis of an ideology that views patients as passive recipients of health care. It has led to an inherent tendency to ‘blame’ the patient and view non-compliance as irrational and deviant. The professional view of non-compliance as irrational, is exemplified in the case of individuals with mental illness, where there are inherent assumptions that non-compliance can be seen primarily as a symptom of illness. This denies the legitimacy of patient choice, and has led to attempts to control compliance via suggested legislative measures. Serious moral and ethical problems arise from such measures, and can be seen as the ultimate legitimization of an ideology of non-compliance. The maintenance of professional power and control is suggested as central to the debates surrounding non-compliance. The ideological assumptions underpinning the concept of non-compliance need questioning, and a re-conceptualization of the roles of patients and professionals is required. This must involve a view of patients as active participators in their own health care. Research based on an interpretative epistemology, aimed at understanding individual action, rather than control, would seem a more appropriate model to pursue.